TARE or TACE: Making informed choice for Liver cancer treatment
In our society, there is always a craze for new things. There is no difference among doctors and some patients. Now if as a patient, you have lots of money and are willing to be treated with all the options, there is no need to read further. I have been a patient and a caregiver for cancer patients and elderly patients and I have been on both sides. None of us have all the money needed to complete all treatment requirements and careful analysis of cost benefit in any treatment is important, especially treatments with marginal benefits.
The new fad among hepatologists and interventional radiologists in Bangalore is TARE. Let us look into the benefits of TARE and how it benefits patients with liver cancer.
Please read this blog article as a preview to the current blog article:
https://mightblog2k16.blogspot.in/2013/06/if-you-are-diagnosed-with-liver-cancer.html
There are only two curative treatments in liver cancer - resection of cancer (cut out the tumour) and liver transplantation (give a new liver to the patient). The result of these treatments are good. Our patients who undergo liver resection for HCC have very good life at 1 and 3 years (at 1 year survivors are 95% and 70% at 3 years). Liver transplants for liver cancer have 70% 5 year survival.
All other treatments are just treatments that prolong the days without curing the cancer. They all have a role, but the role is prolong the days so that transplant can be done.
This is the most important understanding that every patient must have.
What are arterial therapies in liver cancer treatment?
When the patient has multiple liver cancer spots and the quality of the liver is good, and we want the tumour to be under control till liver transplant, we treat patient with bridge therapies.
There are 2 bridge therapies - burning or cooling or destroying the liver cancer and treatment through liver blood vessels. The first one is RFA (Radio frequency ablation), MWT (Microwave therapies) and the others are TACE (Chemotherapy through the artery) and TARE (radiotherapy through the artery)
How do you make the choice?
If the size of the cancer is < 3 cm, ablation or destructive treatments have very good impact to control cancer growth. This is the recommended treatment.
If the size of the cancer > 3 cm, some type of arterial therapy is needed. The next decision is made based on whether the liver is okay to bear the treatment. The bilirubin level for TACE should be less than 3 mg/dl and the bilirubin for TARE treatment should be < 2 mg/dl. If the bilirubin levels are higher, there is a high risk that the liver may fail after treatment.
What is the most important follow up?
The immediate attention should be to the course of liver disease and make sure that the patient's liver does not fail.
At 3 months, a CT scan will show how much the tumour has responded to the treatments.
These are the established principles for treatment. All other options must be discussed with the family and decisions taken only after detailed discussion.
The new fad among hepatologists and interventional radiologists in Bangalore is TARE. Let us look into the benefits of TARE and how it benefits patients with liver cancer.
Please read this blog article as a preview to the current blog article:
https://mightblog2k16.blogspot.in/2013/06/if-you-are-diagnosed-with-liver-cancer.html
There are only two curative treatments in liver cancer - resection of cancer (cut out the tumour) and liver transplantation (give a new liver to the patient). The result of these treatments are good. Our patients who undergo liver resection for HCC have very good life at 1 and 3 years (at 1 year survivors are 95% and 70% at 3 years). Liver transplants for liver cancer have 70% 5 year survival.
All other treatments are just treatments that prolong the days without curing the cancer. They all have a role, but the role is prolong the days so that transplant can be done.
This is the most important understanding that every patient must have.
What are arterial therapies in liver cancer treatment?
When the patient has multiple liver cancer spots and the quality of the liver is good, and we want the tumour to be under control till liver transplant, we treat patient with bridge therapies.
There are 2 bridge therapies - burning or cooling or destroying the liver cancer and treatment through liver blood vessels. The first one is RFA (Radio frequency ablation), MWT (Microwave therapies) and the others are TACE (Chemotherapy through the artery) and TARE (radiotherapy through the artery)
How do you make the choice?
If the size of the cancer is < 3 cm, ablation or destructive treatments have very good impact to control cancer growth. This is the recommended treatment.
If the size of the cancer > 3 cm, some type of arterial therapy is needed. The next decision is made based on whether the liver is okay to bear the treatment. The bilirubin level for TACE should be less than 3 mg/dl and the bilirubin for TARE treatment should be < 2 mg/dl. If the bilirubin levels are higher, there is a high risk that the liver may fail after treatment.
What is the most important follow up?
The immediate attention should be to the course of liver disease and make sure that the patient's liver does not fail.
At 3 months, a CT scan will show how much the tumour has responded to the treatments.
These are the established principles for treatment. All other options must be discussed with the family and decisions taken only after detailed discussion.
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